En español | Mary Adamson remembers the morning before her first shift caring for COVID-19 patients. The 63-year-old intensive care unit (ICU) nurse in Philadelphia was getting dressed when an unexpected thought stopped her cold.
"I thought to myself, I could die from this,” she recalls.
It was a fear she had rarely faced in her 27 years as a nurse, and it only grew as data emerged showing that those age 50 and older were especially vulnerable to the coronavirus. But Adamson didn't let fear stop her. Like thousands of other nurses across the country, she has spent the past year taking care of sick and dying COVID-19 patients, often without a break.
Now, as vaccinations roll out and the stress on hospitals starts to ease, many nurses are grappling with the emotional and mental fallout of the pandemic. The long hours, their fear of the virus, the early lack of personal protective equipment (PPE), their frustration at people who refuse to take precautions and, especially, their grief over the many, many patients they lost — it all took a toll.
"There was just so much sadness and so much death and just zipping up body bags all day,” Adamson says. “Halfway through, I said, ‘I'm getting out. I can't take it.’ But I rallied and I'm still going.”
A recent Washington Post-Kaiser Family Foundation poll found that about 3 in 10 frontline health care workers are considering leaving their profession because of the pandemic. More than half are burned-out, the survey shows, and 62 percent said the pandemic had a negative impact on their mental health.
The pandemic highlighted the “incredible personal and professional sacrifices” that nurses make every day, says Susan C. Reinhard, a nurse and senior vice president at AARP, who is chief strategist for the association's Center to Champion Nursing in America, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.
In honor of Nurses Week, AARP asked frontline nurses age 50 and older to share their stories of the pandemic, what they've learned and how they coped. Here's what they want the rest of us to know.
They are emotionally and physically exhausted
Nurses we interviewed described a relentless parade of patients, overflowing ICU units and long days of rushing between patients. Natalie Correll-Yoder, 61, a clinical nurse specialist for critical care services at NorthBay Healthcare in Fairfield, California, says there were several weeks when she worked 12-hour shifts seven days in a row.
"It was nonstop caring for really sick patients,” she recounts. “Our beds would be all full, and as soon as one patient left, a new one came it. There were days you were lucky to get to the bathroom. … It was the most exhausting thing I've ever experienced."
To preserve PPE, nurses took on many jobs that other hospital workers usually perform, from sanitizing rooms to delivering meals. “You completed so many tasks in a 12-hour period that it felt like a whole week's worth of work,” Adamson says.
Cindy Little, 61, an ICU nurse manager at Novant Health Presbyterian Medical Center in Charlotte, North Carolina, instituted mandatory afternoon water breaks after noticing nurses coming out of patients’ rooms soaked in sweat from the heavy PPE. “You're covered head to toe in plastic, and you might have to spend three or four hours caring for a patient,” she says. “The perspiration just drains off of you."
Fearing for their lives took a toll
Jim Cobb, a 54-year-old emergency room nurse who worked on Native American reservations in Arizona and South Dakota, was constantly worried that he would get the coronavirus and bring it home to his wife, who is immunocompromised.
"If I had caved into terror and my thoughts — I'm going to die; I'm going to bring this home — I would not have been able to go to work. I was worried all the time,” Cobb notes. “I had to tell myself, This is what I'm here to do. I prayed about it... I tried to compartmentalize.”
Cobb, who is Catholic, found that praying the rosary helped to quiet his spinning brain when he needed to sleep. “It helps get your mind off your last patient that you're worrying about or about another nurse quitting.”
Others say they found solace in meditation, exercise or therapy. Adamson talked weekly to a counselor who donated her time to health care workers during the pandemic. The sessions helped her cope with the stress of the job and helped change her mind about quitting.
Nurses have never seen so much death
Although nurses are accustomed to dealing with death, they say the sheer number and pace of coronavirus fatalities was overwhelming.
They would lose a patient, spend a few minutes praying over the body and then have to quickly prepare the deceased for the morgue and clean the bed for the next patient. On the busiest days, nurses might repeat that cycle four or five times, recalls Connie Thigpen, 52, director of critical care at Baptist Medical Center in San Antonio.
"So many didn't make it,” Thigpen says. “Even those of us who have been around a long time, when you deliver that much bad news, it wears on your psyche.”
Linda Sienkiewicz, 59, a care coordinator for naviHealth who helps arrange post-acute care for hospital patients in southeast Michigan, says she normally goes months without a patient death, but during the height of the pandemic, 10 to 12 were dying every week.
"When I'd boot up the computer and look to see what cases were waiting for me, I'd go down the list at a glance and see the ages, and I'd know that's going to be a hard day,” she says. “It weighs on your heart.”
Keeping family members apart was painful for them, too
Hospital visitation restrictions, although necessary to keep patients safe, made nurses’ jobs especially challenging. While they say they tried to loop in family members through telephone and video calls, they knew it wasn't enough. Some families weren't shy about expressing their anger and frustration at the policy.
"What I want people to know is that it broke, and still breaks, our heart that you couldn't be there with your loved one. It really, really hurt us,” Little emphasizes. “We knew we couldn't provide that same level of comfort to patients without their family.”
Little's voice catches as she describes one scene that often replays in her mind: “When one gentleman was dying, we had 20 of his family members on Zoom. A nurse and a nurse in training were there, holding his hands, as his family sang him to heaven.”
They grieve for the patients they lost
Although every loss was difficult, nurses have certain patients they carry close to their hearts: the husband and wife married 43 years who died on the same day, pregnant women who miscarried, young people driven to suicide during a time of social isolation. Many nurses also lost hospital colleagues and friends to COVID-19.
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Because of hospital visitation restrictions, nurses developed closer-than-normal relationships with many COVID-19 patients, Adamson says, which made losing them that much harder.
"Before they were intubated, you got to know them; you talked to them because they had nobody else. A lot of times with COVID, they would die really suddenly. It was just … hard,” Adamson says, haltingly. “I still have moments when I break down.”
After feeling unprotected, deep concerns linger
Some nurses say they felt abandoned by hospital administrators and the government's inability to get them the protection, staffing and public support they needed.
Although they were hailed as heroes, nurses in some cities had to write letters and hold protests demanding adequate supplies, including PPE, and many health care workers died without it. “The hospitals were not protecting us,” Adamson says. “I hope that [the pandemic] exposes some of the real problems in the for-profit health care system."
Others say they find it discouraging when people refuse to wear masks or take the pandemic seriously. “Here you are working very hard in the hospital to save lives, and then you go out in public and you see people not taking precautions,” says Dan Lovinaria, 55, a certified nurse anesthetist at the Minneapolis Veterans Affairs Health Care System. “It was incredibly frustrating.”
Thigpen adds: “What we heard so many times is, ‘It's not real. You guys are making this up.’ … And then it lands on top of your family and you believe it.”
You can support them by getting vaccinated
Nurses say the coronavirus crisis taught them how strong they could be, how to work together more efficiently and how to quickly adapt to changing circumstances. “Our staff has learned an unbelievable new level of teamwork,” Correll-Yoder observes. “This has really bonded them in a completely different way.”
As the pandemic wanes, nurses are taking the time to do things they have put off. Little held her grandchildren for the first time in eight months. Sienkiewicz and her husband bought the second home they've always wanted. Lovinaria, after seeing how hard COVID-19 hit patients with obesity, high blood pressure and other underlying conditions, has been taking better care of himself and is going to the gym five days a week.
"We are always putting things off and saying, ‘I'll do it another time,’ “ Sienkiewicz says. “[The pandemic] opened our eyes to say, There's no time like the present.”
Nurses agree that the biggest silver lining of all was the rapid development of safe and effective COVID-19 vaccines. When the first doses came down the hall of Little's hospital, she says everyone “was standing in the hall cheering and clapping.”
The best way the public can support nurses right now is to get one of those vaccines, nurses say. “Please, go and get vaccinated,” Correll-Yoder stresses. “We don't want to do this again. We don't want more people to die.”
Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation's top consumer publications. Her work has appeared in Reader's Digest, Real Simple, Prevention, The Washington Post and The New York Times.